Journal Article Annotations
2023, 2nd Quarter

Suicide

Annotations by Liliya Gershengoren, MD
July, 2023

Suicidal ideation and attempts in brain tumor patients and survivors: A systematic review.

PUBLICATION #1 — Suicide

Suicidal ideation and attempts in brain tumor patients and survivors: A systematic review.

Mohammad Mofatteh, Mohammad Sadegh Mashayekhi, Saman Arfaie, Yimin Chen, Armaan K Malhotra, Mohammed Ali Alvi, Nicholas Sader, Violet Antonick, Mostafa Fatehi Hassanabad, Alireza Mansouri, Sunit Das, Xuxing Liao, Roger S McIntyre, Rolando Del Maestro, Gustavo Turecki, Aaron A Cohen-Gadol, Gelareh Zadeh, Keyoumars Ashkan.

Abstract: Neurooncol Adv. 2023 May 12;5(1):vdad058. doi: 10.1093/noajnl/vdad058. eCollection 2023 Jan-Dec.

Background:
Subsequent to a diagnosis of a brain tumor, psychological distress has been associated with negative effects on mental health as well as suicidality. The magnitude of such impact has been understudied in the literature. We conducted a systematic review to examine the impact of a brain tumor on suicidality (both ideation and attempts).

Methods:
In accordance with the PRISMA guidelines, we searched for relevant peer-reviewed journal articles on PubMed, Scopus, and Web of Science databases from inception to October 20, 2022. Studies investigating suicide ideation and/or attempt among patients with brain tumors were included.

Results:
Our search yielded 1,998 articles which were screened for eligibility. Seven studies consisting of 204,260 patients were included in the final review. Four studies comprising 203,906 patients (99.8%) reported elevated suicidal ideation and suicide attempt incidence compared with the general population. Prevalence of ideation and attempts ranged from 6.0% to 21.5% and 0.03% to 3.33%, respectively. Anxiety, depression, pain severity, physical impairment, glioblastoma diagnosis, male sex, and older age emerged as the primary risk factors associated with increased risk of suicidal ideation and attempts.

Conclusion:
Suicidal ideation and attempts are increased in patients and survivors of brain tumors compared to the general population. Early identification of patients exhibiting these behaviors is crucial for providing timely psychiatric support in neuro-oncological settings to mitigate potential harm. Future research is required to understand pharmacological, neurobiological, and psychiatric mechanisms that predispose brain tumor patients to suicidality.

Annotation

The finding:
This systematic study revealed that patients with brain tumors, including survivors, have higher rates of suicidal ideation and suicide attempts than the general population. This is the first comprehensive analysis of people with brain tumors who have had suicidal thoughts and attempts.

Strength and weaknesses:
The total number of patients reported in this review serves as the largest available pooled data examining suicidality in brain tumor patients. However, there is heterogeneity among the articles reviewed with smaller studies identifying a more precise relationship between factors related to suicidal behavior and suicidality. Other factors, such as personality traits, psychiatric support strategies provided, and cognitive functions were not consistently reported, making comparisons more challenging. In addition, five of the seven studies reviewed did not specify the rate of suicide attempts resulting in mortality.

Relevance:
Patients’ distress and despair may worsen as a result of their brain tumor diagnosis and treatment. In extreme circumstances, patients and survivors may exhibit suicidality at a higher rate than the general population. It is essential to recognize suicide risk among these patients so that timely treatment may be provided in neuro-oncological settings to reduce potential harm. Patients with brain tumors must receive comprehensive follow-up care, which includes psychiatric risk assessment and treatment.